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What to Expect

What Happens Before, During and After Treatment?

Once a diagnosis of cancer has been made, you will probably talk with your primary care physician along with several cancer specialists, such as a radiation oncologist, a medical oncologist and a surgeon. You will want to ask about all your treatment options.

In many cases, your cancer will need to be treated by using more than one type of treatment. For example, if you have breast cancer, you might have surgery to remove the tumor (by a surgeon), then have radiation therapy to destroy any remaining cancer cells in or near your breast (by a radiation oncologist). You also might receive chemotherapy (by a medical oncologist) to destroy cancer cells that have traveled to other parts of the body. After reviewing your medical record including imaging, as well as completing a thorough patient history and physical examination, your radiation oncologist will discuss the potential benefits and risks of radiation therapy with you and answer your questions.

Before Treatment

Meeting With a Radiation Oncologist

If you are considering radiation therapy, schedule a consultation with one of our radiation oncologists. During your first visit, we will evaluate your specific situation to determine if radiation therapy will be helpful in treating your disease. This includes reviewing your current medical history, past medical history, past surgical history, family history, medications, allergies, lifestyle and current symptoms. The doctor will also perform a detailed physical exam to assess the extent of your disease and assess your general physical condition. Your medical record will be reviewed including any relevant imaging and laboratory studies. Frequently, your care will be discussed among a multidisciplinary group of specialists including medical oncologists, surgeons, radiologists and pathologists to individualize treatment recommendations. We will discuss the benefits, risks, side effects and treatment alternatives of radiation therapy with you and caregivers. Your cancer care team will also include a dedicated oncology nurse navigator who will guide you through your cancer treatment and rehabilitation, and an expert oncology nutrition counselor who will help you get the nutrients you need during cancer treatment and recovery. If you decide to receive radiation therapy, you will proceed to treatment planning at the appropriate time.

Simulation

Radiation therapy must be precisely delivered to the treatment target area, each time treatment is given. The process of positioning your body to help your team direct the beams of radiation safely and accurately to their intended locations is called simulation. During simulation, your radiation oncologist and radiation therapist place you on the simulation machine in the exact position you will maintain during the actual treatment. Immobilization devices such as molds, casts, headrests or other devices are customized to help you remain in the same position during the entire treatment. The radiation therapist, under the radiation oncologist’s supervision, marks the area to be treated on the immobilization devices and/or on your skin with either a bright, temporary paint or a set of small, permanent tattoos. Often, a special treatment planning CT scan is done to help with the treatment planning. This CT scan is in addition to prior diagnostic CT scans and helps with designing the placement and shape of the radiation beams. This process is used to direct the radiation to your tumor and keep the radiation away from healthy tissue.

Treatment Planning

Once you have finished simulation, your radiation oncologist and other members of the treatment team review information obtained during simulation along with your previous medical tests to develop a treatment plan. The goal of radiation therapy is to develop a plan that maximizes the dose to the cancer cells and minimizes the dose to healthy tissues. Radiation treatment technique and radiation dose, as well as beam angles and shapes will be selected during the planning process. A team of experts including your radiation oncologist, medical physicist and dosimetrist will work together to develop the radiation treatment plan. A sophisticated treatment-planning computer and associated software will be used to help design the best possible treatment plan. After reviewing all of this information, your radiation oncologist will write a prescription that outlines exactly how much radiation you will receive and to what parts of your body.

Quality Assurance Before Treatment

Once your radiation oncologist approves the radiation therapy plan developed in treatment planning, members of the radiation treatment team work together to ensure that your specific treatment plan works correctly on the linear accelerator before treatment begins.

During Treatment

External Beam Radiation Therapy Treatments

When you undergo external beam radiation therapy treatment, each session is painless, just like getting an X-ray. The radiation is directed at your tumor from a machine located away from your body, usually a linear accelerator. External beam radiation is noninvasive. One of the benefits of radiation therapy is that it is usually given as a series of outpatient treatments so you don’t have to stay in the hospital. You may not need to miss work or experience the type of recuperation period that may follow more invasive treatments.

The radiation therapist will deliver your external beam treatment following your radiation oncologist’s instructions. If an immobilization device was made during simulation, it will be used during every treatment to make sure that you are in the exact same position every day. Radiation therapists position you for treatment and set up the equipment. Time spent in the treatment room will vary depending on the complexity of plan.

Once you are positioned correctly, the therapist will leave the treatment room and enter the control room next door to begin your treatment. During your treatment, your therapist will closely monitor you on a television screen. There is a microphone in the treatment room so you can always speak with the therapist if you have any concerns. The machine can be stopped at any time if you are feeling sick or uncomfortable.

The radiation therapist may move the treatment machine and treatment table to target the radiation beam to the exact area of the tumor. The machine might make noises during treatment that sound like clicking, knocking or whirring, but the radiation therapist is in complete control of the machine at all times.

Your radiation oncologist monitors your daily treatment and may alter your radiation dose based on these observations. Also, your doctor may obtain other tests such as blood tests and imaging to see how your body is responding to treatment. If the tumor shrinks or if your body changes significantly, another simulation may be required. This allows your radiation oncologist to change the treatment to destroy the rest of the tumor and spare even more normal tissue.

Treatments are usually scheduled five days a week, Monday through Friday, and continue for 1-7 weeks. The number of radiation treatments you will need depends on the tumor, location and type of cancer you have, the goal of treatment, your general health and other medical treatments you may be receiving. Radiation oncologists will take all of this into account when determining your treatment course.

A portion of your external radiation therapy may be directed at the tumor and surrounding tissues at risk for harboring microscopic cancer cells. This might be followed by shrinkage of the volume of tissue treated to the tumor area itself, since this area may require a higher dose to eliminate the cancer cells. This is called a boost.

Weekly Checkups

During radiation therapy, your radiation oncologist and nurse will see you regularly to follow your progress, evaluate whether you are having any side effects, recommend treatments for those side effects (such as medication) and address any concerns you may have. Your doctor may also make changes in the schedule or treatment plan depending on your response or reaction to the therapy. Your radiation oncology team will gather on a regular basis with other health care professionals to review your case to ensure your treatment is proceeding as planned. During these sessions, all the members of the team discuss your progress and any concerns.

Quality Assurance During Treatment

During your course of treatment, correct positions of the treatment beams will be regularly verified with images made using the treatment beam itself. These images (called port films, beam films or portal verification) represent an important quality assurance check but do not evaluate the tumor itself. Depending upon what kind of treatment you receive and what your doctor thinks will work best, the type of images used (X-ray, CT scan, ultrasound, etc.) may vary. These images assure your radiation oncologist that the treatment set up accurately matches the intended target.

After Treatment

Follow-Up

After treatment is completed, follow-up appointments will be scheduled so that your radiation oncologist can make sure your recovery is proceeding normally. Your radiation oncologist, in concert with other members of your team, may order additional diagnostic tests. Reports on your treatment may be sent to the other doctors helping treat your cancer.

Unique to our centers is our STAR Program®, a certified Cancer Rehabilitation program, which provides well-coordinated, first rate cancer care from STAR-certified medical professionals. Continued follow-up in the radiation oncology centers is recommended to evaluate for long-term side effects of radiation therapy and to ensure that the cancer does not return. As time goes by, the number of times you need to visit your radiation oncologist throughout the year will decrease. However, you should know that your radiation oncology team will always be available should you need to speak to someone about your treatment.